Effect of intravenous thrombolysis before endovascular therapy on outcomes in patients with large core infarct

Mohammad Anadani; Eyad Almallouhi; Ilko Maier; Sami Al Kasab; Pascal Jabbour; Joon-Tae Kim; Stacey Q Wolfe; Ansaar Rai; Robert M Starke; Marios-Nikos Psychogios; Edgar A Samaniego; Adam S Arthur; Shinichi Yoshimura; Hugo Cuellar; Brian M Howard; Ali Alawieh; Isabel Fragata; Adam J Polifka; Justin R Mascitelli; Joshua W Osbun; Charles Matouk; Min S Park; Michael R Levitt; Travis M Dumont; Richard Williamson; Alejandro M Spiotta

doi:10.1136/jnis-2022-019537

Effect of intravenous thrombolysis before endovascular therapy on outcomes in patients with large core infarct

J Neurointerv Surg. 2023 Dec 21;15(e3):e414-e418. doi: 10.1136/jnis-2022-019537.

Authors

Mohammad Anadani¹, Eyad Almallouhi², Ilko Maier³, Sami Al Kasab², Pascal Jabbour⁴, Joon-Tae Kim⁵, Stacey Q Wolfe⁶, Ansaar Rai⁷, Robert M Starke⁸, Marios-Nikos Psychogios⁹, Edgar A Samaniego¹⁰, Adam S Arthur^{11

12}, Shinichi Yoshimura¹³, Hugo Cuellar¹⁴, Brian M Howard^{15

16}, Ali Alawieh¹⁵, Isabel Fragata¹⁷, Adam J Polifka¹⁸, Justin R Mascitelli¹⁹, Joshua W Osbun²⁰, Charles Matouk²¹, Min S Park²², Michael R Levitt²³, Travis M Dumont²⁴, Richard Williamson²⁵, Alejandro M Spiotta¹

Affiliations

¹ Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA [email protected] [email protected].
² Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
³ Neurology, University Medicine Goettingen, Goettingen, Germany.
⁴ Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
⁵ Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea.
⁶ Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
⁷ Radiology, West Virginia University Hospitals, Morgantown, West Virginia, USA.
⁸ Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
⁹ Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
¹⁰ Neurology, Radiology and Neurosurgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
¹¹ Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
¹² Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
¹³ Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
¹⁴ Neurosurgery, LSUHSC, Shreveport, Louisiana, USA.
¹⁵ Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁶ Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁷ Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
¹⁸ Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
¹⁹ Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
²⁰ Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA.
²¹ Neurosurgery, Yale University, New Haven, Connecticut, USA.
²² Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
²³ Neurological Surgery, University of Washington, Seattle, Washington, USA.
²⁴ Department of Surgery, Division of Neurosurgery, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USA.
²⁵ Neurology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.

PMID: 36990690
DOI: 10.1136/jnis-2022-019537

Abstract

Background: The safety and efficacy of bridging therapy with intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) in patients with large core infarct has not been sufficiently studied. In this study, we compared the efficacy and safety outcomes between patients who received IVT+MT and those treated with MT alone.

Methods: This is a retrospective analysis of the Stroke Thrombectomy Aneurysm Registry (STAR). Patients with Alberta Stroke Program Early CT Score (ASPECTS) ≤5 treated with MT were included in this study. Patients were divided into two groups based on pre-treatment IVT (IVT, no IVT). Propensity score matched analysis were used to compare outcomes between groups.

Results: A total of 398 patients were included; 113 pairs were generated using propensity score matching analyses. Baseline characteristics were well balanced in the matched cohort. The rate of any intracerebral hemorrhage (ICH) was similar between groups in both the full cohort (41.4% vs 42.3%, P=0.85) and matched cohort (38.55% vs 42.1%, P=0.593). Similarly, the rate of significant ICH was similar between the groups (full cohort: 13.1% vs 16.9%, P=0.306; matched cohort: 15.6% vs 18.95, P=0.52). There was no difference in favorable outcome (90-day modified Rankin Scale 0-2) or successful reperfusion between groups. In an adjusted analysis, IVT was not associated with any of the outcomes.

Conclusion: Pretreatment IVT was not associated with an increased risk of hemorrhage in patients with large core infarct treated with MT. Future studies are needed to assess the safety and efficacy of bridging therapy in patients with large core infarct.

Keywords: CT; Stroke; Thrombectomy; Thrombolysis.

MeSH terms

Brain Ischemia* / therapy
Cerebral Hemorrhage / etiology
Endovascular Procedures* / adverse effects
Fibrinolytic Agents / adverse effects
Humans
Mechanical Thrombolysis* / adverse effects
Retrospective Studies
Stroke* / diagnostic imaging
Stroke* / drug therapy
Thrombectomy
Thrombolytic Therapy / adverse effects
Treatment Outcome

Substances

Fibrinolytic Agents